| NPI | 1508543265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2025028082) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.255669) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-07-09 |